October 31, 2014

So You’ve Decided To Transition, Now What?

Caroline Hippler shares key terms and advice for those navigating a change in gender.

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symbol for transgender

symbol for transgender

Navigating the Transition

Congratulations! You have decided to transition, or somehow change your body or gender presentation to be congruent with your gender identity. Arriving at this decision required a great deal of introspection and strength. As you begin this process, it will be empowering at times and likely frustrating or unjust at others. My goal is to provide you with a wide scope of information to help you carve out the transition that is right for you.

Before we begin, a quick note about terms. Throughout this article, I am going to use the word “transgender” to refer to people whose gender identity is different than the one they were assigned at birth. Transgender is a large word incorporating a large number of identities. There is no one right way for a transgender person to identify or present. For some, identifying as a transgender person means identifying as a man or a woman; for others it means identifying as neither. There are some who reject the term altogether because they feel that it endorses a false gender binary. I choose to use it because it is accepted by most as an umbrella term for folks who are gender variant in some way.

For more discussion of gender terms, take a look at Dr. Eric Anthony Grollman’s articles here and here. If you are a significant other, partner, friend, family member, or ally supporting someone going through a transition, you can find helpful information here and here.

Take Care of Yourself

The change you are undertaking will take a good deal of your energy; things will be much more positive if you are physically and mentally healthy.

Mental Health

There are a lot of ways to be mentally healthy. Any time we change our lives, we are met with new thoughts, feelings, and experiences that might be overwhelming. Therapy is a place to process these new thoughts and feelings. But not just any therapist will do: just like your other relationships, you want to find someone that you like and you can trust. The most productive work comes out of a good relationship between you and your therapist. Your relationship with your therapist is not the same as with a friend. That’s a good thing. A therapist is an outsider in your life and because of that they can provide a different perspective and challenge you in ways that friends might avoid.

A therapist should never try to convince you to change your gender identity. The goal of therapy should be to increase your overall well-being; if you sense something else is going on, address it with your therapist. If they persist, take the necessary steps to extricate yourself from that relationship.

In the interest of full disclosure, I acknowledge that I am a therapist. I happen to think that therapy is a great option for most people (as you might expect) and, with the therapist that is right for you, a lot of productive work can be done.

For a select few people, therapy may be a poor fit. If that is your case, you will need another space to process and examine your experiences. Perhaps you have a close relationship with a religious leader or you have a strong, formal social network. Make your needs known to them and ask if they’ll be a support for you during your transition.

Whichever route you choose, talk to someone – someone you trust and with whom you feel safe and who can provide whatever help you need.

Physical Health

In addition to taking care of your mental health, it is important to attend to physical health. Exercise is great for mood, no matter who you are. For folks considering any kind of medical transition (or any medical procedure, for that matter), taking care of your body in advance will aid recovery and efficacy of treatment.

Becoming Informed About Different Transition Pathways

If it wasn’t clear from the discussion about terms, there is a great deal of heterogeneity among folks who transition. The path that you choose to take for your transition will be highly personal and based on who you are and what you value. There is no one right way to transition.

Regardless of the path you travel, along the way you will encounter gatekeepers with a range of functions. They might be a therapist who writes a letter of referral to the doctor you want to see, a doctor that writes a prescription for the drug you need, or a cashier who requires payment before you leave with your binder. You may be feeling vulnerable and perhaps become frustrated with the various gatekeepers that you meet. Gatekeepers are often well-intentioned and some would argue that gatekeepers are there to keep you safe – safe from incompetent practitioners, hasty decisions, and inadequate care. There are others who feel they restrict a transgender individual’s right to health care. Regardless of your perspective, gatekeepers may hold a certain amount of power over outcomes in your life, and when possible, it is important that you identify gatekeepers who are transparent and inclined to act in your interests.

Physically Transitioning

People who transition physically do so in many ways. Physical transitioning can involve wearing different clothing, changing the way you walk, taking hormone treatments, undergoing surgical procedures and more. There is no single correct way to transition. If transitioning is a movement toward honesty, it is up to you to determine how you will feel most comfortable and authentic. Depending on what that decision is, the steps you take may look different.

As I mentioned before, if you choose to medically transition in any way (hormones, hair removal, surgery, etc) you will have to interact with various gatekeepers. For example, if you are seeking medical transition, you may be required to see a therapist. Within the health care system, gender variance is considered a mental disorder called “Gender Dysphoria.” In order to get hormone prescriptions or surgery, doctors will often require a letter from a therapist asserting that you have the “condition” and are a good candidate for health care.

The World Professional Association for Transgender Health (WPATH; formerly the Harry Benjamin International Gender Dysphoria Association, HBIGDA) has released extensive guidelines and standards of care for health care providers describing how to treat individuals diagnosed with Gender Dysphoria, the term used by psychologists and defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; find information about its creation here). The treatment course they suggest consists primarily of mental health therapy, hormone therapy, and possibly surgery.  If this is the way you choose to transition, it will behoove you to familiarize yourself with this (somewhat long) document. Many mental health practitioners refer to these recommendations when making treatment decisions and, as they are gatekeepers in this process, it would help to know what guides their decisions. That being said, not every health care practitioner agrees that the WPATH Standards of Care are the right path for every individual who wants to transition and they won’t all use these standards of care. Some argue that the standards need to embrace greater diversity in gender expression and decentralize the therapist’s role as gatekeeper. Just as you would carefully select a therapist, the same care should be taken with doctors to ensure that you will be able to obtain the services and support that you need with minimal effort.

It is up to you to reflect on your values and identity and to balance what is right for you and the extent of bureaucratic, medical, and financial barriers you are willing to overcome. For a list of some local health care resources, visit IU’s GLBT Student Support Office. For national and international organizations, there is also this list compiled by the Kinsey Institute.

Socially Transitioning

Part of the process of transitioning involves dealing with reactions to your transition from others. You may choose to “come out” to friends and family, which requires decisions to be made about context and timing. Interactions with strangers and acquaintances may require reflection and adjustment. Social transitioning also involves choosing the name and gender pronouns you will ask others to use to refer to you.

Whatever the elements of your social transition, it is important to define those elements for yourself and plan accordingly. For an in depth exploration of social transitioning, see Skye Brown’s excellent booklet “Socially Transitioning for Trans* People”. Skye provides a great deal of detail about coming out in different contexts, holding yourself and others accountable, and resources to turn to for support.

If you are seeking social support and are in the Bloomington area, consider reaching out to the student group Gender Warriors at gwarrior@indiana.edu.

Legally Transitioning

As part of your transition, you may want to legally change your name or gender marker on official documentation such as your driver’s license or passport. Accomplishing either of these tasks will involve a visit to the court, paying fees, and getting approval from legal gatekeepers. In Monroe County, Indiana this involves filing a name change, putting a notice in the newspaper, and appearing in court. The judge does not have to grant your name or gender change but if they do, you will then have to take the necessary steps to have that change reflected on your documentation.

This process can be quite burdensome and may require advanced financial planning. The legal system has been slow to catch up with the reality of gender diversity; you may be frustrated that you have to do any of this at all to have your identity recognized. For now, these are the barriers that stand between you and the legal identity to which you have a right. It is imperative that you find a way to take care of yourself during this process: invite a friend to court, track your accomplishments on social media, or meet regularly with someone who will listen to your struggles.

Most importantly, educate yourself about this process. Knowing your rights is an essential element of obtaining recognition of those rights. For a detailed look at legally transitioning in Indiana, read Skye Brown’s booklet, “Legally Transitiong for Trans* People”. Skye provides thorough information about many steps and aspects of this process as well as resources for further assistance.

Ask: What am I giving up?

With any change comes loss. A successful transition might be described as one in which you gain far more than you lose, but moving forward also means leaving some things behind. Sometimes folks ask this question as a way of discouraging you from being who you choose to be. That is not the intent of this question. Rather, ask yourself this question so you can be as prepared and healthy as possible during your transition. Recognizing the coming changes and saying goodbye to things will help as you work to solidify a new identity. For example, if you currently present as male, you are giving up male privilege. If you present as female, you’ll find yourself opening all of your own doors. The privileges, social expectations and norms you lose might be social aspects you resent or hate; taking a moment to acknowledge their role in your life to this point and to say goodbye will allow you to let go and open up space for your new experiences. For one person’s individual experience of transitioning, check out this article.

Find Support

As you embrace your identity and move through the process of transitioning, it is essential to find support. Turn to friends, family, pets, music, television – anything that reduces your stress or facilitates your honesty. The GLBT National Help Center offers peer-counseling and resource connection through their national hotline at 1-888-843-4564.

Caroline Hippler works in Bloomington, IN as a therapist in private practice. She received her Master’s in counseling from Indiana University and is working toward licensure. Visit her website at www.carolinehippler.com.